Indeterminate Human Immunodeficiency Virus Type 1 Western Blots: Seroconversion Risk, Specificity of Supplemental Tests, and an Algorithm for Evaluation

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Abstract
The human immunodeficiency virus type 1 (HI V-1) Western blot is indeterminate in 10%–20% of sera reactive by EIA. Eighty-nine individuals with prior repeatedly reactive EIA and indeterminate Western blots were followed prospectively to study the risk ofseroconversion and specificity of supplemental tests. Four high-risk cases seroconverted within 10 months after enrollment (seroconversion risk, 4.5%, 95% confidence interval, 1.2%–11.1%). Among cases with p24 bands initially, 4 (18.2%) of 22 high-risk individuals seroconverted compared with 0 of 33 low-risk cases (P = .03). Specificities of HI V-I culture, serum p24 antigen, polymerase chain reaction, and recombinant ENV 9 EIA were 100%, 100%, 98.6%, and 94.4%, respectively. An expedited evaluation protocol is proposed. Low-risk individuals with nonreactive EIAs upon repeat testing do not need further follow-up; high-risk individuals should be followed serologi-cally for at least 6 months, especially those with p24 bands on Western blot.

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